Off-Label Use of Intravitreal Bevacizumab (Avastin) for Salvage Treatment in Progressive Threshold Retinopathy of Prematurity

Lalwani, Geeta A.; Berrocal, Audina M.; Murray, Timothy G.; Buch, Maria; Cardone, Scott; Hess, Ditte J.; Johnson, Russell; Puliafito, Carmen A.

doi:10.1097/iae.0b013e3181644ad2

Cited by 118 publications

(55 citation statements)

References 12 publications

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“…The present study used one-third of the adult dosage (0.06 ml) with the same concentration. This dosage was based on the approximation that a premature infant's eye is one-third of the volume of an adult eye, and the reported maximal volume for IVB in premature infants without complications is 0.05 ml (1.25 mg) (22). Fortunately, in the present case, the bacterial infection was controlled without complications.…”

Section: Discussionmentioning

confidence: 73%

Early clinical characteristics of bacterial endophthalmitis in retinopathy of prematurity after intravitreal bevacizumab injection: A case report

Wang

Xiang

2017

Experimental and Therapeutic Medicine

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Abstract. Intravitreal bevacizumab injection (IVB) is emerging as a safe and effective therapy for retinopathy of prematurity (ROP); however, follow-up investigations after IVB have indicated that endophthalmitis, a rare and devastating complication, may develop. The present study reports a case of an infant with ROP who developed endophthalmitis after IVB infection. The infant was administered with an intravitreal injection of broad-spectrum antibiotics to treat the endophthalmitis. A favorable anatomic outcome was achieved after follow-up. From this case, it was discovered that the early clinical characteristics of endophthalmitis infection secondary to IVB in premature infants include: i) The clinical symptoms of endophthalmitis infection appearing as early as 3-5 days after IVB; ii) a white membranous plaque on the retina surface with an obscure circular boundary; iii) a plaque that enlarges to a gray flocculent mass and intrudes the vitreous body, where the hazing surrounds the lesion; and iv) conjunctival hyperemia and cornea edema in the anterior segment of the affected eye. This case also indicated that timely retinal screening with RetCam or a binocular ophthalmoscope 3-5 days after IVB may be effective for detecting early stage endophthalmitis in infants who are unable to complain of a loss of visual acuity. From the present case report, it is advisable that the same type of screening be performed 3-5 days after other types of eye surgery, such as cataract extraction surgery, to detect early stage endophthalmitis. Furthermore, the present case also revealed that an early intravitreal injection of broad-spectrum antibiotics may be an effective treatment for premature infants with bacterial endophthalmitis.

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Section: Discussionmentioning

confidence: 73%

Early clinical characteristics of bacterial endophthalmitis in retinopathy of prematurity after intravitreal bevacizumab injection: A case report

Wang

Xiang

2017

Experimental and Therapeutic Medicine

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“…Intravitreal anti-VEGF therapy has been increasingly used in severe ROP cases; hence, whether or not the systemic leakage of anti-VEGF can cause any short-or longterm adverse effects on the tissues or organs has always been an issue (10)(11)(12)(13)(14). The effects of this therapy on other tissues, including the lungs, were not investigated thoroughly in the present study, although we have previously reported a better systemic clinical course of BPD in preterm babies after the injection of IVB (10).…”

Section: Discussionmentioning

confidence: 99%

“…In addition, in recent years a new treatment modality involving the intravitreal injection of anti-VEGF (vascular endothelial growth factor) agents (intravitreal bevacizumab (IVB)) has been used in the treatment of ROP with high success rates of up to 100% in even the most aggressive forms of the disease (10)(11)(12)(13)(14). However, anti-VEGF agents can gain access to the systemic circulation following an intravitreal injection (15)(16)(17)(18)(19), and the systemic adverse effects of intravitreal anti-VEGF agents have always been a concern.…”

Section: Introductionmentioning

confidence: 99%

Effects of Intravitreal Anti-VEGF Therapy on the Clinical Course of Bronchopulmonary Dysplasia

et al. 2016

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Objectives: To demonstrate the effects of the injection of intravitreal bevacizumab (IVB) on the clinical course of established bronchopulmonary dysplasia (BPD). Methods: This is a multicenter retrospective case-control study performed without any randomization or masking procedure. A total of 70 patients with BPD, including 35 cases (the IVB group) and 35 controls (the control group) were studied. Patients in the IVB group received intravitreal anti-VEGF (bevacizumab) treatment for type 1 prethreshold retinopathy of prematurity (ROP). The control group consisted of infants with BPD whose gestational age, birthweight, and gender were matched with those of the IVB group. None of the infants in the control group needed to be treated for ROP using either anti-VEGF or laser photocoagulation. Results: There was no statistically significant difference (P = 0.11) between the groups in terms of the total duration of oxygen prior to the IVB injection (65.9 ± 23.5 and 79.1 ± 33.1 days in the IVB group and control group, respectively). However, after the injection of IVB, the total duration of oxygen was significantly lower in the IVB group (mean 7 (1 -70) days vs. 16 (1 -98) days, P = 0.01). In 14 cases with mild BPD and their matched controls, the median time (25% -75%) for the discontinuation of oxygen therapy was 3 (2 -7) days and 10 (5 -15) days, respectively (P = 0.36). In 21 cases with moderate and severe BPD and their matched controls, the median time (25 -75%) for the discontinuation of oxygen therapy was 14 (7 -21) days and 22 (16 -43) days, respectively (P = 0.024). Conclusions: Intravitreal bevacizumab injection treatment for ROP cases with BPD was found to be associated with a shorter duration of oxygen use. The results of the study not only demonstrate a pathogenic correlation between ROP and BPD through an abnormal vasculogenesis, but also raise a question regarding whether or not the systemic side effects of IVB are actually adverse.

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“…3,5,19 Law et al 19 reported on 13 eyes of 7 infants who received initial treatment with IVB to improve visualization of retina. Definitive treatment was then performed within 72 h with either laser or surgery.…”

Section: Eyementioning

confidence: 99%

“…1 Off label use of bevacizumab has been shown to be an effective treatment for type 1 ROP. [2][3][4][5] Bevacizumab Eliminates the Angiogenic Threat of Retinopathy of Prematurity (BEAT-ROP) randomized trial reported significant treatment benefit with bevacizumab over laser for stage 3 plus ROP in zone I. 2 However, reports of late recurrence and development of retinal detachment necessitate frequent follow-up for an extended time period post treatment.…”

Section: Introductionmentioning

confidence: 99%

Involution patterns of retinopathy of prematurity after treatment with intravitreal bevacizumab: implications for follow-up

Isaac

Tehrani

Mireskandari

2016

Eye

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Off-Label Use of Intravitreal Bevacizumab (Avastin) for Salvage Treatment in Progressive Threshold Retinopathy of Prematurity

Abstract: Off-label use of bevacizumab appears to be useful as a salvage treatment for ROP when laser treatment is precluded. It improves dilation, quiets the disease when visibility is difficult, and temporizes the disease until laser can be supplemented.

Cited by 118 publications

References 12 publications

Early clinical characteristics of bacterial endophthalmitis in retinopathy of prematurity after intravitreal bevacizumab injection: A case report

Early clinical characteristics of bacterial endophthalmitis in retinopathy of prematurity after intravitreal bevacizumab injection: A case report

Effects of Intravitreal Anti-VEGF Therapy on the Clinical Course of Bronchopulmonary Dysplasia

Involution patterns of retinopathy of prematurity after treatment with intravitreal bevacizumab: implications for follow-up

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